Preoperative biliary drainage for distal obstruction: the case against revisited
Date
2010
Authors
Garcea, G.
Chee, W.
Ong, S.
Maddern, G.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Pancreas, 2010; 39(2):119-126
Statement of Responsibility
Giuseppe Garcea, Wilson Chee, Seok Ling Ong and Guy J.Maddern
Conference Name
Abstract
OBJECTIVES: No conclusive evidence exists confirming the role of preoperative biliary drainage (PBD) in reversing the physiological disturbances resulting from biliary obstruction to improve outcome. This review examined the impact of PBD and the outcomes after surgery. METHODS: A PubMed literature search was undertaken using the keywords preoperative, biliary, and drainage. The primary end points were the effect of PBD on mortality, morbidity, and bile cultures. The secondary outcome measures were PBD and pancreatic leakage, intra-abdominal abscess, sepsis/infectious complications, wound infection, hemorrhage, and bile leak rates. The impact of bile cultures positive for bacteria and the outcomes after surgery were also examined. RESULTS: Preoperative biliary drainage significantly increases wound and bile infection rates on meta-analysis (P < 0.0005) using a fixed and random effect model, but no adverse effect on mortality and morbidity was found. A bile culture positive for bacteria negatively impacts on both mortality and morbidity (P < 0.005) after surgery. CONCLUSIONS: Preoperative biliary drainage significantly increases the rates of bile culture positive for bacteria and the probability of wound infection. Bile cultures positive for bacteria adversely impact mortality and morbidity after surgery in jaundiced patients. Although no evidence has been found by this review that PBD directly increases mortality and morbidity, it is possible that in certain patients, PBD may deleteriously affect outcome by bacterial contamination of the bile.
School/Discipline
Dissertation Note
Provenance
Description
Access Status
Rights
(C) 2010 Lippincott Williams & Wilkins